Introduction to Medicare and Medi-Cal for Seniors

Agenda The different parts of Medicare: what is covered under each part costs and eligibility requirements. Medi-Cal: what is covered, costs and eligibility requirements. Long Term Care (it is not covered under Medicare and may be covered under Medi-Cal).

Medicare Federal/National Program for Seniors 65 years and older Created in 1965 by US Congress US citizens or legal residents for at least 5 years For Spouses, each person must reach age 65 to be eligible Four Parts: A, B, C and D

Medicare Part A Covers Inpatient Hospital Stay: semiprivate room, food and tests Free if you have worked in this country for 40 quarters. If not, $441 a month if you are otherwise eligible (citizen or legal resident for 5 years) One copay at the beginning of $1,184 for up to 60 days of hospital stay, more if staying longer

Medicare Part B Covers physicians fees and outpatients services, lab and diagnostic tests such as x- rays and MRIs, ambulance transportation etc. Optional, costs $ a month even for those with 40 quarters of employment First meet deductible of $ and then generally Medicare pays 80%, you pay 20% Doctor seeing you in a hospital is paid under Part B

Medicare Part C Medicare Advantage Plans – Private insurance companies funded partly by Medicare and partly by you. Regulated by CMS (Centers for Medicare & Medicaid Services) You pay your Part B premium of $ plus added amount of around $250 a month. You get some additional benefits such as dental, vision care and sometimes even gym memberships. Some plans also cover Prescription Drugs, which is not covered by either A or B.

Medicare Part D Prescription Drug Plan - Went into effect on Jan – youngest member of the family Administered by private companies. Must be enrolled either in Part A or B to be eligible. Drugs covered is not standard. Each insurer has their own formulary: drug and dosage combination. What is “donut hole?” Once you and your drug plan have spent a given amount ($2970 for 2013), you will have to pay more for your drugs( % for brand name, 79% for generic) till you reach catastrophic coverage (2013- $4,750) when the insurance plan starts paying a much larger amount.

2013 Costs at a Glance Part A premiumMost people don't pay a monthly premium for Part A. If you buy Part A, you'll pay up to $441 each month. Part B premiumMost people pay $ each month. Wealthy pay more. Part B deductible$147 per year Part A hospital inpatient deductible Days 1-60: $1,184 for each benefit period Part B ServicesGenerally, coinsurance of 20% of the Medicare approved amount

Affordable Care Act of 2010 AKA Obamacare, mostly about private insurance for ages <65, some effects on Medicare Gradually closing the donut hole for Part D till 2020 Limits for costs for in-network care for Part C enrollees Part B and D costs restructured to be less for most and more for the wealthy

Medi-Cal Medicaid is the health program for families with limited income and assets – funded by states and federal government, different in each state. Medi-Cal is the Medicaid Program for the state of California – usually no coinsurance, that is you do not have to pay 20% etc. like Medicare Dual-eligibles: Qualify for Medicare and Medi-Cal. Medi-Cal pays for all the Medicare costs listed previously. It also covers services that Medicare does not cover. Dental services discontinued in July 2009 – partially restored from May 2014

Santa Clara County Medi-Cal Contracts with Santa Clara Valley Health Plan or Anthem Blue Cross Good Resource: Guide to Medi-Cal in Santa Clara CountyGuide to Medi-Cal in Santa Clara County For most of us office is: North County District Office, 100 Moffett Boulevard Mountain View, CA 94043

Medi-Cal Eligibility If you get SSI, you are automatically eligible for Medi-Cal. You have to live here for 5 years to qualify for SSI. If you are over 65, meet income and asset criteria and are a green card holder, you are eligible for Medi-Cal. OK to have one home, one car as assets. Otherwise very minimal limits, (world-wide income? Not sure) Must prove state residency - easy

Qualified Medicare Beneficiary - QMB Medi-Cal pays your Medicare Part A and B premiums as well as other Medicare out-of- pocket expenses Must qualify for Medicare – US citizen or legal resident for 5 years. If 40 quarters of employment then no Part A premium. Income and asset limits more than for straight Mede-Cal – for form, use link below ( orms/mc14a.pdf) orms/mc14a.pdf

Medi-Cal Rates medi-cal-primary-care-rates-will-increase-to medi-cal-primary-care-rates-will-increase-to Currently, California's rates rank 47th in the nation and are on average 50 percent below Medicare rates. Because of these low rates, two-thirds of California’s physicians cannot afford to participate in the program and more than 50 percent of Medi-Cal patients report they can’t find a doctor.

Medicare with Medi-Cal If you are over 65, once you become a citizen or you have been a green card holder for 5 years, you can apply for Medicare during the Open Enrollment Period (October 15– December 7) If you qualify Medi-Cal will pick up your Medicare premiums and other costs More choices of doctors with this option.

Over 65, what are my choices? Get insurance from India – I don’t know much about this Get private insurance – some choices in the web- insurance-for-green-card-holders/ insurance-for-green-card-holders/ Get Medi-Cal if you satisfy the income and asset limitations If you are a US citizen or have held your green card for 5 years, you can apply for Medicare or Medicare Advantage Have Medi-Cal pay for Medicare if you satisfy asset and income limitations

Long Term Care Medicare has very limited support for long term care in skilled nursing facility. Also, limited home health care. No coverage for assisted living or retirement community Medi-Cal covers nursing facilities as well as services to help you stay in your home or assisted living facility. Depends on income, assets, “level-of-care” needed.

Useful Links income/medi-cal.html income/medi-cal.html Immigration & Citizenship Table Guide to Medi-Cal in Santa Clara County QMB Application